Exam 1 Flashcards
1
Q
Penicillin is ______ and inhibits bacterial cell wall synthesis by______.
A
bacteriocidal; causing cell lysis
2
Q
Penicillinase Inhibitors (4)
A
clavulanic acid
tazobactam
sulbactam
avibactam
3
Q
structurally related to PCN with only 5-15% of PCN allergic pts showing cross sensitization.
A
cephalosporin
4
Q
Large macro molecules
A
Macrolides
5
Q
Macrolides are ____ in usual doses and ____ in higher doses
A
static; cidal
6
Q
Side effects of macrolides (3)
A
GI upset
cramping
diarrhea
7
Q
Aminoglycosides are for gram ____ infections and be both static and tidal depending on the dose
A
negative
8
Q
Aminoglycosides can exhibit ___ ___ __ , persistent suppression of bacterial growth after brief exposure to abx.
A
Post antibiotic effect (PAE)
9
Q
Antibiotic with poor CNS penetration.
A
ahminoglycosides
10
Q
Quinolones are ____ spectrum antimicrobials and are _____.
A
broad; cidal
11
Q
Quinolones are good for pneumonia because ______.
A
they have excellent tissue penetration
12
Q
A side effect of quinolone are that they inhibit _________
A
cartilage synthesis
13
Q
What are the quinolone medications for 2, 3, and 4th generations?
A
2nd: cipro every 6 hours
3rd: levofloxacin
4th: moxifloxacin
14
Q
Metroconidazole is used for _____ infections
A
protozoal
15
Q
Not true abx but antimetabolites but can be cidal or static based on the dose by inhibiting ____ biosynthesis.
A
sulfonamides; folate
16
Q
Minimal concentrations in the blood and tissue but can result in pulmonary toxicity with long use especially in the elderly
A
Urinary Antiseptics (nitrofurantoin)
17
Q
How much of the world population is affected by TB?
A
1/3
18
Q
How long is the minimum treatment for TB?
A
6 months if active
19
Q
What are the target sites of antiviral medications? (3)
A
- reverse transcriptase inhibitors (NRTIs & NNRTIs)
- protease (inhibitors)
- fusion inhibitors
20
Q
Numbers of bacteria in voided urine that excess numbers commonly seen due to contamination of urethra.
A
significant bacteriuria (10^5/ml)
21
Q
Clinical syndrome of flank pain
A
acute pyelonephritis
22
Q
Infection if a structurally & neurologically normal urinary tract
A
uncomplicated UTI
23
Q
Complicated UTIs
A
Men
pregnancy
children
24
Q
95% of UTI infections are _____
A
mono bacterial
25
_____ is the most common cause of UTI
e.coli
26
Diagnostic techniques for UTI (3)
dipstick leukocyte esterase (LE)
dipstick urine nitric (UN)
urine culture ***
27
Streptococcus progenies commonly causes
pharyngitis (strep throat)
| respiratory and skin infection
28
Streptococcus pneumoniae commonly causes____
penumonia
sepsis
otitis media
meningitis
29
Strep pneumoniae is ______
diplococci
30
80-90% of clinical isolates; major enterococcal organism of the GI tract
E. faecalis
31
5-15% of clinical isolates; increasingly vancomycin resistant
E. Faecium
32
Inhibit gram (+) cell wall synthesis and demonstrate time-dependent killing (time above the MIC)
PCN
33
How long does Bicillin C-R last?
24 hours
34
Used to treat serious MSSA blood stream infections
Nafcillin
35
Types of carboxypenicillins (2)
Carbenicillin (Geocillin)
| Ticarcillin (Ticar)
36
1st PCN with activity towards P. aeruginosa
Carbenicillin (Geocillin)
37
2-4 times more activity against p. aeruginosa, rarely used alone due to beta lactase hydrolysis and usually given with IV clavulanate
Ticarcillin (Ticar)
38
Type of ureidopenicillin that inhibits 60-90% P seruginosa strains and used with beta lactase inhibitor, tazobactam (zosyn)
Piperacillin (Pipracil)
39
MRSA is resistant to all current _______
cephalosporins
40
phenoxymethyl penicillin; acid stable
Pen V
| (only for oral use in Na+ or K+ salts
41
Used to identify MRSA
methicillin/Oxacillin
42
used to treat serious MSSA bloodstream infections, that is HEPATICALLY metabolized and no adjustment for renal impairment
Nafcillin
43
-OH at para position improves oral absorption (oral equivalent of ampicillin)
Amoxacillin (Amoxil)
44
Most are active against staph and strep; increasing generations have higher Gram (-) activity, decreasing Gram (+) activity
cephalosporins
45
Which generation of cephalosporins have significant activity vs anaerobes (Bacteroides fragilis) and is useful in abdominal and GI surgical prophylaxis
Second generation (Cefotetan and cefoxitin)
46
Name of 3rd generation IV cephalosporin
cefitriaxone (rocephin)
47
Where is cefitriaxone metabolized?
hepatic metabolism
48
What population is 3rd generation ORAL cephalosporin used?
children
49
What are the 3rd generation IV Cephalosporins? (3)
cefotaxamine (claforan)
ceftazidime (fortaz)
ceftriaxone (rocephin)
50
What 3 rd generation IV cephalosporin has the best activity against P-aeruginosa but may accelerate acquires resistance?
ceftazidime (fortaz)
51
What 3rd generation IV cephalosporin with used with Azithromycin for community acquires pneumonia?
ceftriaxone (rocephin)
52
What generation of cephalosporins have the widest spectrum and why?
4th generation; enhanced activity against many gram (-)
53
Why are the 4th generation cephalosporins useful against many multi drug resistant gram negative bacteria?
70-80% gram negative bacili resistant to ceftazidime are sensitive to 4th generations
54
What is the 4th generation cephalosporins available in the US?
Cefepime (maxipime)
55
Broadest activity of the beta lactam class due to improved beta lactamase stability
Carbapenems
56
What does carbapenems have excellent coverage for?
gram (+), (-) and anaerobic
57
What carbapenem has the better gram (+) coverage?
Imipenem
58
Which carbapenems have better gram (-) coverage?
Merropenem & Ertapenem
59
Which carbapenem is used in combo with cilastin, prevents renal absorption and has higher incidence of seizures?
Imipenem (Primaxin)
60
What carbapenems have a lower incidence of seizures?
Meropenem (Merrum)
61
What carbapenems have excellent anaerobic coverage for diabetic foot ulcers?
Ertapenem (Invaz)
62
What carbapenem is the newest agent with little coverage against P.aeruginosa?
Doripenem (doribax)
63
What monobactam has no cross reactivity with PCN?
Aztreonam (Azactam)
64
Concentration dependent 'cidal' acticity (peak concentration above MIC) effected against most gram (-) organisms including pseudomonas
Aminoglycosides
65
Common agents of aminoglycosides?
Gentamycin, Tobramycin, Amikacin
66
Traditional dosing of ahminoglycosides?
q8-12 h
67
High dose extended interval (HDEI) of aminoglycosides
q24hr
68
When are aminoglycosides trough levels drawn?
prior to next dose
69
What are the peak levels of aminoglycosides?
IM injections: 1 hour after injection
60 min infusion: immediately after infusion
30 min infusion: 30 mins after infusion
70
bacteriocidal for most anaerobic agents with good oral absorption (same PO/IV dosing)
Metronidazole (flagyl)
71
How is Metronidazole absorbed?
hepatically metabolized (no renal adjustment)
72
What is metronidazole effective for?
C. difficile colitis
73
Side effect of clindamicin?
Diarrhea occurs in 20% patients (oral >IV)
74
What are the macrocodes (3)?
erythromycin
clarithrmycin
azithromycin
75
What is the erythromycin frequency and a common AE?
QID; significant GI upset
76
What is the frequency of clarithrmycin?
BID; less GI upset
77
What is the frequency of azithrymycin? What is significant about this med?
q 24h, least GI upset
78
What is a class of macrocodes that has the initial agent of telithromycin (Ketek)?
Ketolides
79
What was the black box warning for Ketolides in 2007?
Increased risk of hypoglycemia in type 2 DM
80
What are the ketolides still approved for?
Community acquires pneumonia
81
What is the glycopeptide that was initially relegated to PCN allergic patients?
Vancomycin
82
What glycopeptide had increased use in the 1980s due to MRSA?
Vancomycin
83
What is the side effect of the streptogramins (Quinipristin-Dalfoprstin(Synercid))?
30% experience irritation of the venous site
9% experience arthalgias
6% experience myalgias
RARELY USED
84
Is the lipopeptide-Daptomycin(Cubicin) bacteriostatic or cidal?
bacterioCIDAL
85
Which Oxazolidinone is used for gram (+) organisms including MRSA and vanco resistant E. faecium(VRE faecium)
Linezolid (Zyvox)
86
What forms is linezolid available? where is it metabolized? Is it bacteriostatic or cidal
IV and PO
Hepatically metabolized
BacterioSTATIC
87
What is the method in which TMP/SMX works?
blocks consecutive steps in bacterial folate synthesis
88
What is TMP/SMX extensively used for and what is the PO dose?
UTIs
| 1 DS tab q12h
89
Fluorine derivatives greatly improved potency
quinolones
90
What is the mechanism of quinolones?
MOA: cidal, inhibition of DNA gyrase and topoisomerase IV
91
Quinolones are most active against gram _____ organisms and ______ resistance emerges if used as mono therapy
negative; pseudomonas
92
What is the adverse effect of quinolones with <<1%
achilles tendon rupture
93
What are 2 things to note about quinolones?
not recommended for peds
| all prolong the QT-interval
94
What is the dosing for cipro for cystitis?
250mg q12h x 3 days
| IV 200mg
95
What is the dosing of cipro for lower respiratory tract infection?
500-750mg q12h v 7-14 days
| IV 400mg
96
What is the quinolone that is hepatically metabolized that is recently FDA approved for UTIs
Moxifloxacin (Avelox)
97
What are the IV to PO criteria?
```
Afebrile > 24 hours
WBC normal or normalizing
tolerating oral diet
NO N/V
No contraindications to PO therapy
```
98
What type of clearance method if Cockcroft? And what are the 2 things it assumes?
calculated
"stable" renal. function
"normal" muscle mass
99
What is the Cockcroft formula for males?
(140-age x IBW (kg))/ (72kg x serum creatinine))
100
What type of clearance method is creatinine clearance?
Measures
101
How do you calculate female creatine clearance?
(CrCl Male) x 0.85
102
In AKI prevention what are the nephrotoxic agents that should be avoided? (6)
```
amoniglycosides
amphotericin B
Radiocontrast agents
Cyclosporin & Tacrolimus
ACE & ARBs
NSAIDs
```
103
What are the kidney functions? (3)
excretory (fluid, electrolytes, solutes)
Metabolic (vitamin D, some drugs, insulin & beta lactase)
Endocrine (EPO)
104
What are the diuretic classes? (5)
```
thiazides
carbonic anhydrase inhibitors
potassium-sparing
osmotic
loop
```
105
What do thiazide diuretics INCREASE the EXCRETION of
Na, CL, K, & Mg (decrease serum levels)
| supplement with oral K &Mg
106
what do thiazides DECREASE the EXCRETION of?
CA & uric acid (increase serum levels)
| use with caution in gout; useful in osteoporosis
107
Are thiazides potent?
NO only moderately efficacious
108
What is the CrCl for which thiazides are mostly not effective?
CrCl < 30 **exceptions are Indapamide(Lozol) and Metolazone (Zaroxylyn)
109
Which med is has limited usefulness as diuretic but is occasionally used for edema of HF and for open-angle glaucoma
carbonic anhydrase inhibitors- Acetazolamide (Diamox)
110
Postassium sparing diuretics are usually used with what medications to minimize potassium loss?
K+ losing thiazides
111
Potassium sparing diuretics, both Na channel blockers (late distal tubule) and aldosterone antagonists can cause what?
hyperkalemia
112
What are the Na channel inhibits that are K sparing?
amiloride & triamterene
113
What is a aldosterone antagonist that is K sparing?
spironolactone (aldactone)
114
What are the side effects of spironolactone?
gynecomastia and impotence
115
What is the diuretic of choice for hepatic cirrhosis?
spironolactone
116
What is the CrCl for spironolactone and dose?
CrCl 10-50mL/min: q24 hour
117
When do you avoid spironolactone?
CrCl<10
118
What is an IV osmotic diuretic?
Mannitol
119
What is the osmotic diuretic used for cerebral edema?
mannitol
120
Why does mannitol have to be stored at room temperatures?
It will crystalize at low temps
121
What are the other types of osmotic diuretics that are rarely used clinically?
Glycerine
Isosorbide
Urea
122
Why do you have to individualize therapy with loop diuretics?
most potent class of diuretics
123
What are the 4 major loop diuretics available?
furosemide (lasix)
bumetanide (bumex)
ethacrynic avid (Edecin)
Torsemide (demanadex)
124
What are the adverse effects of loop diuretics?
ototoxity (tinnitus, deafness and vertigo-usually reversible)
hyperuricemia (rarely gout)
hyperglycemia
125
Why is the loop diuretic, lasix is good for oral absorption?
excellent bioavailability
126
When is the risk of ototoxicity increased with lasix?
if given IV at 4mg/min (high dose)
127
What is lasix used for mostly and what is the dose?
acute pulmonary edema
| 40mg IVP over 1-2 min, increase to 80mg IVP in inadequate response
128
What thiazide can be added with lasix for refractory for synergistic effect every 24 hours?
metolazone (zaroxlyn)
129
What is different with IV vs PO lasix?
IV may use less furosemide than intermittent dosing
130
What is the ceiling effect?
inability of a drug to produce additional effects ABOVE a certain maximum effect dose (in diuretics)
131
What is the preferred loop diuretic in patients with persistent fluid retention despite high doses of other loops?
torsemide
132
What is a urinary acidifying agent?
ammonium chloride
133
What do urinary alkalizing agents eliminate?
increase elevation of asa
134
What are the urinary alkalinizing agents? (2)
Na Bicarbonate
| K Citrate
135
What are the first line agents of phosphate binders? (4)
```
calcium carbonate (tums)
calcium acetate (phoslo)
Sevelamer HCL (Renagel)
Sevelamer Carbonate (Renvela)
```
136
What is the second line agent for phosphate binding?
lanthanum (Fosrenol)
137
What is the target serum of PO4 for calcium acetate and sevelamer (phosphate binder)?
< 6mg/dL
138
What are the adverse effects of mild hypercalcemia (>10.5mg/dL)
constipation, anorexia, N/V
139
What are the adverse effects of severe hypercalcemia (>12 mg/dL)?
delirium, stupor, coma
140
What patients is sevelamer (Renagel) useful?
patients with hypercalcemia
141
What phosphate binder may reduce Vit D, E and K and folate absorption?
Sevelamer (Rengel)
142
What phosphate binder is anion-exchange resin, and may induce metabolic acidosis in patients on HD?
Sevelamer (Renagel)
143
What is beginning to replace Sevelamer (Renagel)?
Sevelamer Carbonate (Renvela)
144
What is the newest phosphate binder that is expensive with little advantage?
lanthanum carbonate (fosrenol)
145
What is a potassium binding agent?
sodium polystyrene sulfonate (Kayexalate)
146
What are the adverse effects of sodium polystyrene sulfonate (kayexalate)?
```
hypocalcemia
hypokalemia
hypomagnesemia
consitpation- impaction
N&V
```
147
What is important to monitor with potassium binding agent, sodium, polystyrene sulfonate?
electrolytes and EKG!
148
What is the beginning treatment for CKD anemia? Why is it important to titrate dose?
elemental Fe; to minimize GI upset
149
Why is it important to be careful with using IV iron for CKD?
iron accumulation/overload is associated with increased mortality
150
What are the IV iron formulations (2)?
```
ferric gluconate (ferrlecit)
Iron sucrose (venofer)
```
151
Water-soluble complex iron salt that is added to the hemodialysate soliution?
Ferric Pyrophosphate Citrate (FPC, Triferic)
152
What are the advantages of ferric pyrophosphate citrate (FPC, Triferic)?
progressive iron accumulation does not occur
reduces the use of costly ESAs
inexpensive- can treat multiple pets
153
What are the erythropoiesis-stimulating agents?
Epoetin Alfa (Epogen & Procrit)
154
What are the ESAs?
recombinant human erythropoietin
155
What are the benign prostatic hyperplasia(BPH) medication classes?
alpha 1-antagonists
| 5 alpha-reductase inhibitors
156
What are the alpha 1-antagonists for BPH? (3)
tamsulosin (climax)
Alfuzosin (Uroxatral)
Soldosin (Rapaflo)
157
What catalyzes conversion of testosterone to dihydrotestosterone (DHT)?
5 alpha-reductase inhibitors
158
What is mainly is prostate and hair follicles?
Type II 5 alpha reductase (5AR)
159
What are the 5 alpha reductase inhibitors?
proscar
| propecia
160
Selective for type II 5AR and category X for pregnant females- SHOULD NOT HANDLE TABS
5 alpha reductase inhibitors: finasteride (proscar, propecia)
161
Selective for both type I & II 5-alpha reductase( nonselective) and a category X for pregnancy
Dutasteride (avodart)
